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VESS Paper Session

VESS05 - Long-term Survival in Medicare Patients Undergoing Interventions for Peripheral Arterial Disease is Poor

Wednesday, June 15, 2022
1:38 PM – 1:51 PM EDT
Objectives: Interventions for peripheral arterial disease often balance invasiveness with durability and clinical benefit. This balance is particularly important for determining whether and how to intervene for intermittent claudication (IC) and can help guide chronic limb threatening ischemia (CLTI) treatment. Our goal was to assess survival for both IC and CLTI in Medicare patients.

Methods: The Vascular Implant Surveillance and Interventional Outcomes Network (VISION) Vascular Quality Initiative Medicare linked data was used to assess long-term survival among peripheral vascular intervention (PVI), infrainguinal bypass (IIB), and suprainguinal bypass (SIB) registries. Demographics, comorbidities, and interventions were recorded. Medicare linkage was used for survival data. Multivariable analysis was used to identify independent associations with mortality.

Results: There were 31,457 PVI (45% IC, 55% CLTI), 7978 IIB (27% IC, 73% CLTI), and 2149 SIB (50% IC, 50% CLTI) interventions in Medicare patients. The average ages were 75 for PVI, 73 for IIB, 72 for SIB with male sex in 57% of PVI, 64% of IIB, and 52% of SIB. PVI interventions were iliac (24.6%), femoropopliteal (40%), tibial (11.5%), and multilevel (23.9%).

The 5-year mortality for PVI was 37.2% for IC and 71.1% for CLTI, for IIB was 37.8% for IC and 60% for CLTI, and for SIB was 33.8% for IC and 53.8% for CLTI. Across all procedures, end stage renal disease, CLTI, congestive heart failure, anemia, chronic obstructive pulmonary disease, and prior major amputation were associated with higher 5-year mortality (Table 1). Preadmission home living, preoperative statin and antiplatelet use were associated with lower long-term mortality.

Conclusions: Long-term survival in Medicare patients undergoing interventions for PAD is poor, particularly for CLTI where almost two-thirds of treated patients were not alive at 5 years. Survival for IC, while higher, is also poor for patients undergoing life-style benefiting procedures. This data can help guide discussions and expectations with patients about the type of intervention for CLTI and the benefits of any intervention for IC.